Administrative burden, costs come with participating in Medicare quality program

Three out of 10 MGMA research respondents create “superbill” addendumsto capture quality-reporting codes

PHILADELPHIA, Oct. 29, 2007 – Medical group practices that participate in Medicare’s quality reporting program incur additional administrative work and costs, according to new research by the Medical Group Management Association (MGMA).

For two years, Medicare has hosted a voluntary program for physicians to report codes to the government regarding “quality” protocols and services performed in their practices. The 2006 program was called the Physician Voluntary Reporting Program (PVRP); it is now called the Physician Quality Reporting Initiative (PQRI). Of practices responding to an MGMA questionnaire, 11 percent participated in the PVRP and 44 percent are reporting measures for the PQRI. Notably, nearly all responding practices that participated in the PVRP chose to take part in the PQRI and are reporting five measures on average.

At the time of the quality-program launch, MGMA members raised significant concerns, including the fact that medical practices must report clinical information through insurance claim forms. Administrators worried that this would result in inconsistent interpretation of reporting measures and new overhead costs for practices.

Medical groups participating in the Medicare quality program reported costs and burdens they have incurred:

Approximately 35 percent indicated that they had to create an addendum to their “superbill” paperwork to capture information to report the quality codes;

On average, practices assigned one employee to the administration and oversight of program reporting;

Approximately 22 percent required additional staff support; and

Seventeen percent had to increase staff salaries.

“MGMA supports efforts to improve quality and standardize physician quality measures, including the American Medical Association’s Physician Consortium for Performance Improvement and the AQA,” said William F. Jessee, MD, FACMPE, MGMA president and CEO. “A fundamental challenge our members are experiencing with Medicare’s quality program is the additional administrative burden.”

Respondents remain uncertain about how the reporting of the PQRI measures correlates with an improvement in patient outcomes. Only 13 percent of participants in the research rated the PQRI’s helpfulness to patients as good or excellent; 16 percent rated improvement of care outcomes as good or excellent.

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Additionally, respondents indicated low satisfaction with the information they receive about the PQRI. They rated the following measures below average (on a scale of 1 to 5, with 5 being excellent and 1 being poor):

Transparency to providers (2.38);

Whether the program is “beneficial and worthwhile to the practice” (2.32); and

Overall satisfaction with PQRI (2.51).

“MGMA and others, in response to the Centers for Medicare & Medicaid Services’ request for input, have been working with the agency in the design of PQRI feedback reports to ensure that they will provide meaningful data for physicians to evaluate their performance,” said Jessee.

MGMA conducted its Medicare quality-program research in September and October, three months into the PQRI. The Association collected responses from 190 members, representing more than 3,079 practicing physicians. MGMA asked respondents about their participation and satisfaction with the initiative. The average respondent group comprised 19 physicians.

“We use an electronic medial record system, so capturing the data has not been all that difficult. However, it takes approximately two to three hours a day,” said Allen Goree, CMPE, an MGMA member who participated in the research. “We have not launched training sessions for our physicians to input the data due to the uncertainty of PQRI funding in 2008. If there is no funding, I doubt we will continue,” said Goree, CEO of the Missouri Heart Center in Columbia.

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About MGMA

MGMA, founded in 1926, is the nation’s principal voice for medical group practice. MGMA’s nearly 21,000 members manage and lead 12,500 organizations, in which almost 270,000 physicians practice. MGMA’s core purpose is to improve the effectiveness of medical group practices, as well as the knowledge and skills of the individuals who manage and lead them. MGMA headquarters are in Englewood, Colo. Visit mgma.com.